Candida, SIBO, or H. Pylori?

byAdmin - Cynthia PerkinsonMarch 6, 2015

Candida, SIBO, or H. pylori (Helicobacter pylori) may occur alone, but they frequently exist in conjunction with one another or one leads to the other at some point. Since many of their symptoms overlap and testing for each of them is not very reliable and complete eradication is very difficult in each condition, it can sometimes be hard to differentiate between the three of them or get an accurate diagnosis.

Since dysbiosis makes one vulnerable to any microbe, Candida may open the door for SIBO or H. Pylori, or vice versa in any direction. Sometimes it can be hard to know which one came first, however, one thing is for certain — they can all perpetuate one another. Each of them can cause inflammation and degradation of the gut lining and compromise the immune system, which then creates an environment that encourages the proliferation of either one.

As we learned in our previous discussion on this topic, overgrowth of bacteria in the small intestine may cause elevated levels of ammonia that increase the gut pH, weaken the immune system, impair function of the ileocecal valve and create leaky gut, and create sympathetic nervous system dominance, all of which would create an ideal environment for Candida to thrive. Hydrogen, which is produced by bacteria, can be used as a source of energy by H. pylori, so SIBO provides a never-ending source of fuel for H. pylori. Additionally, Candida can attach itself to bacteria, which provides it with protection from antifungals.

However, Candida can create opiates, deplete acetylcholine and serotonin, increase histamine and intestinal permeability, impair thyroid function, immunity and the ileocecal valve and can cause sympathetic dominance, all of which could encourage small intestinal bacterial overgrowth. H. pylori can also hide inside of Candida yeast cells.

If H. pylori colonize the small intestine, it will contribute to inflammation and leaky gut that can encourage both SIBO and Candida. If it colonizes the stomach, it will reduce our hydrochloric acid levels, which fosters the overgrowth of other bacteria and Candida.

Intestinal parasites may also perpetuate SIBO or Candida, as it has been found that bacteria can attach to parasites and parasites may harbor yeast inside themselves.

Therefore, if SIBO or H. pylori are present and not addressed when one has Candida, then they may not make much progress in eradicating yeast overgrowth and vice versa. So, it is important that one knows which microbe they are dealing with and address each of them accordingly.

Although it seems counterproductive due to their impact on Candida, a pharmaceutical-based antibiotic may be needed to address bacteria before the use of an antifungal. However, if one uses some of the herbal antibiotics (oregano oil, cat’s claw, berberine, cinnamon, turmeric) many of them are effective against bacteria and Candida, so both issues could be addressed simultaneously.

The symptoms of these conditions are so similar that SIBO is often mistaken for Candida or H. pylori. So, here are a few characteristics about SIBO that I have witnessed in the people I work with, as well as myself, that set it apart from Candida or H. pylori.

SIBO is more painful and the symptoms (particularly the upper GI and center of the abdomen) can be much more severe.

The psychological symptoms of small intestinal bacterial overgrowth are much broader and disruptive.

The diet needs to be lower in carbs and more restrictive with fruit and nuts with bacterial overgrowth and bacteria is much less forgiving than Candida when you stray even a little bit from those restrictions and the complications can be harsher.

The overall health of the individual with SIBO tends to be more compromised.

Gastrointestinal symptoms from small intestinal bacterial overgrowth are more surrounded around the center of the stomach in the belly button area.

Acid reflux, GERD, heartburn, indigestion, and belching tend to be more related to SIBO or H. pylori rather than Candida.

You may indeed have excess gas when carbs are eaten with Candida, but the gas that is produced with SIBO is much more excessive and its smell is wicked. It may smell like ammonia or sulfur.

Stool from someone with bacterial overgrowth smells much fouler than stool from someone with Candida only.

As someone who has dealt personally with Candida for decades and SIBO for only a few years, I can share with you that Candida is a walk in the park compared to SIBO.

H. pylori and SIBO can be hard to distinguish as well, as they both can produce upper GI symptoms like acid reflux, burning sensation in the abdomen, heartburn, and belching. However, H. pylori symptoms (burning sensations of tissue, indigestion, belching) are typically experienced higher up in the abdomen. On the other hand, symptoms from bacteria in the small intestine can radiate out and up.

SIBO and H. pylori both produce a great deal more belching than Candida. SIBO belching originates from lower in the stomach down near the belly button, while H. pylori belching originates higher up. If you pay close attention when belching, you can feel where it originates from.

If you get really in tune with your body, you can also identify where your gas is originating from. When you expel gas, if you can feel it in your upper abdomen, then that is likely SIBO. If you feel it in your lower abdomen, that is likely bacteria or yeast in the colon.

Symptoms that develop as soon as food hits your stomach are more likely to be due to H. pylori because that is the only microbe that can survive in this acidic environment. However, Candida and bacteria do reside in the mouth and esophagus and they become active as soon as food enters the mouth.

If gas begins in about 30 minutes of eating, that indicates that fermentation (due to Candida or bacteria) is taking place in the small intestine, because it typically takes about five or six hours after eating for food to make it to the colon. However, H. pylori may also inhabit the first section of the small intestine, (duodenum), so belching and pain that begins in 30 minutes could also be H. pylori.

You can get a general idea of where your bacteria or Candida are colonized by when your symptoms appear. Earlier on in the digestive process indicates they are higher up in the small intestine, later on in the process indicates they are further down in the small intestine and after five or six hours indicates they are in the colon. However, transit time does vary from person to person, so this may not be exact if one has slower or increased transit time.

Candida responds very well to a low-carb diet; many symptoms will resolve with changes in diet alone. SIBO requires significantly more restriction on the carbs and fiber including fruit and nuts to get relief. If bacterial overgrowth is severe, it may not improve much with diet alone or one may have to eliminate nuts and fruit completely to achieve significant relief. However, not following the diet makes SIBO symptoms unbearable. Additionally, some bacteria will feed on protein and fat when carbs are absent, so even these foods can become problematic to some degree.

H. pylori symptoms will also persist to some degree in the face of low-carb. So, if you are following the Paleo for Candida diet faithfully as I suggest, but still have a lot of upper and middle of the stomach GI symptoms and/or psychological symptoms (depression, anxiety, unexplained fear or paranoia, OCD, brain fog) are persistent, then your focus needs to be more on bacteria and Helicobacter pylori. One should always explore the possibility of parasites as well.

Let me share my personal experience with you to demonstrate how confusing it can be and how SIBO can develop so gradually that you don’t realize it is happening until afterward when you can look back and see how it unfolds.

I’ve been managing Candida in my own life for more than 25 years pretty successfully. Then around the age of 50 I developed new GI problems that didn’t respond very well to my usual regime. The new symptoms were located more in the upper GI and in the small intestine area, where I had never really had symptoms before and they were much more severe. The low-carb, Paleo diet I had been following for years wasn’t working very well to alleviate these symptoms. I had to go even lower carb, down to 25 to 30 grams per day, but I could go to around 60 or 70 grams three times a week. This helped a lot for a while, but gradually things got worse and worse, despite the very low carb diet and removal of FODMAPS. Weird brain symptoms I had never experienced began to develop intermittently as well like intense brain fog, a choppy thought process, and songs or phrases would get stuck in my head and high levels of fear. I knew this wasn’t Candida, because candida had never been this painful, produced gas that smelled this way or this type of brain symptoms.

Initially, these symptoms were attributed to H. pylori and parasites. Parasite treatment helped some, but not everything, and I could keep H. pylori to a minimum, but was not able to eradicate it completely. I came to realize that I had developed a SIBO problem when I was forced to took an antibiotic for a persistent respiratory infection and inadvertently cleared up my gastrointestinal and brain symptoms and made me feel better than I had in a long time. This didn’t use to be the case, in the past, antibiotics would cause a flare in my Candida symptoms and I would feel worse. I then did research and discovered this is an indication that SIBO is present.

At first, I thought I felt better because it cleared up my H. pylori, but several months later I experimented with resistant starch and all those gastrointestinal symptoms and brain dysfunction returned with a vengeance and it was way worse than it had ever been. I was like, “what the heck is going on here?” At this point, the abdominal pain, gas, distention, etc., were excruciating and I couldn’t touch fruit or nuts at all without severe brain symptoms and unbearable gastrointestinal pain. Even protein and fat became problematic, as the bacteria began to eat that as well.

So more research led me to discover that a negative reaction to resistant starch is an indication of small intestinal bacterial overgrowth because they will feed on this substance like any other starch, at which point I came to realize that this fed SIBO and the hydrogen from the SIBO fed the H. pylori. Therefore, I came to understand that my focus now needed to be more on SIBO, but without ignoring Candida or H. pylori, of course. After starting herbal antibiotics, then my symptoms started to dissipate again, which confirmed that the major problem was bacterial. However, the herbals were not powerful enough for me and I was forced to take an antibiotic. I learned the hard way that supplementing with resistant starch can be downright dangerous when small intestinal bacterial overgrowth is present, so please do read my post on this issue to educate yourself.

I hope all of this helps you know what signs to look for and hopefully identify your microbes more quickly.

Fortunately, most of the steps that one will take to improve Candida overgrowth, will also be required and beneficial for H. pylori and SIBO. However, if they are present, this will not be enough. Therefore, the healing plan must address each of these aspects simultaneously or the one that is the most dominant problem may need to be dealt with first. You can learn more about how to address bacteria here and here and how to address Candida here. A post on H. pylori will be coming in the near future. Alternatively, if you need a more personal touch, you can schedule a phone consultation to discuss things in more detail.

Thank you VERY much for this article Cynthia! I have been a sufferer of Candida, Bacterial and or SIBO for the last 7-8 years to the point where I can no longer work. After years of trying to explain my symptoms to my Family Practitioner and listening to her say, “well, your blood work is fine” I asked her to run tests that weren’t considered normal, because I wasn’t fine. I was diagnosed with H. Pylori and treated with 2 types of antibiotics (ab’s) for 10 days. 2 days after completion, my symptoms worsened and I was put back on the same ab treatment after which, I literally thought I was dying! A scope into my stomach revealed a hole in my upper lining, to which the Dr. concluded was a Hiatal Hernia. A LONG story short is that now, 2 1/2 years later, my suspicions about whether I had H.Pylori and a Hernia are being answered with something that makes perfect sense. For anyone reading my comments, I have words of advice for you. DO NOT try to explain any of these types of symptoms to your MD with your thoughts about what you suspect might be the cause! They are likely to conclude, as my VA Medical Records revealed to me, that you are probably suffering from an undiagnosed mental illness.

Thank you so much for this very informative article. I have been suffering with chronic gastritis, esophagitis, hiatal hernia, H. pylori and candida for 8 years now. And no mater how i tried to cure it the symptoms never go away. I can handle all the pain, but the worst thing i can’t handle even in my dreams is my severe halitosis. It smells like cadaver, sulfur or faeces, which affected my entire life to the point that i wouldn’t want to go out in my house because of the embarrassment. I’ve been to low carb, no refined sugar, no dairy diet. I don’t smoke nor drink alcohol. My regular diet is small amount of red rice cooked with turmeric powder, some meat, broth, lots of vegetables, bananas and apples. I also drink yakult probiotic after meals, vco and acv with honey twice a day. But sometimes i ate small amount of bread, cheese and a pc.of chocolate cake, especially when my daughter brought some food from her cooking class. I’ve felt no symptoms after eating them except that i’m being constipated. Sometimes when i’m not eating rice i go for the sweet potato or cassava. I have read many articles about candida and h.pylori, but when i came across the SIBO articles including this site, i felt so worried that i may also have it. Now, i have to eliminate all grains and starches completely from my diet. Oh my! what a torture. Anyway, Thanks a lot madam Cynthia, for this wonderful article. God Bless.

Hi- thank you for the great article. I was diagnosed with H pylori a few months ago – took the specific H.Pylori drug to eradicate it but about 5 days later had almost exact symptoms. what a downer. I had finally started to feel amazing (I had h.pylori for over a year the doctors thought) i had energy, my skin looked great. then BOOM 5 days and I was back to the usual stuff. So i was retested at the appropriate amount of days and my test was negative. Now I am being treated for SIBO as they are related. I am on drugs for SIBO now – no big change in my skin, energy, or loud stomach but I am hopeful. My doctor went to a huge conference about all these gut issues so I am abiding by his 100 billion probiotics, Rx, and low fodmap diet. My question to you is what is the best way to treat these two things long term. Low Fodmap has foods that irritate h.pylori and visa versa so I feel like I’m treating one but maybe growing the other. I am not a sugar eater- never have been – My diet before all this leaned on the side of AIP – I just feel lost and so restricted that I’m eating protein and greens for every meal. Any advice would be appreciated. thanks.

Yes, well the other possibility is that H pylori did not go away (regardless of what your test says). It is rare that it is eradicated with one treatment of an antibiotic. Like all microbial issues, it often gets resistant and treatment needs to be repeated and sometimes ongoing.

The same is true for SIBO. Treatment usually needs to be repeated and the diet (low-carb, low histamine, low Fodmaps, low glutamate and Paleo) needs to be ongoing or it returns.

Probiotics are usually the worse thing you can do for SIBO. When the migrating motor complex is not working properly,(as is the case with SIBO) and we take probiotics, then they remain in the small intestine where they don’t belong and make SIBO worse. Please read the Probiotic section that can be found on the following page.

I can’t take probiotics at all and most people I work with that have SIBO can’t take probiotics. As a matter of fact, I think it was high dose probiotics that I took for Candida that may have led to the development of SIBO. I have worked with clients where it appears that high dose probiotic caused the development of SIBO as well.

Yes, unfortunately, when SIBO is involved you may end up eating nothing but meat and low-starch vegetables. That is just the nature of the beast. You can find a great more detail on everything related to SIBO on the following two pages.

Hi, Thank you for your article. I was diagnosed with SIBO by a naturopath through stool testing. That test did not detect candida nor parasites. However, a muscle tester (applied kinesiology) thinks that I have parasites and candida. The naturopath and the muscle tester have different treatment methods. I am not sure which treatment to start first. I’m inclined to go with the naturopath’s treatment first since she seems to have more definitive “proof,” but friends and family have sworn by this muscle tester and that her treatments have helped them greatly. Do you think it would be more productive to treat SIBO first and then move on to parasites and candida or vice versa? The diets are similar and it may be that what helps one helps the others anyway. Thanks!

You’re welcome. Yes, what helps one will help the other in regard to many factors. However, SIBO is a little more complicated. Probiotics that are helpful for Candida can perpetuate SIBO and the SIBO diet must be a little stricter. If one is taking the herbal route, then one can choose herbs that are effective against SIBO, parasites and Candida. However, if one is going to use a pharmaceutical based antibiotic, then they would want to do that before treating Candida. Same would be true for parasites. It is pretty common for parasites, Candida and SIBO to occur together, as each one perpetuates the other. Be sure to look at the SIBO section found here.

However, I’m curious how your practitioner diagnosed SIBO with a stool test? A stool test cannot really diagnose SIBO. A stool test only tells us what is going on in the colon, not the small intestine. SIBO takes place in the small intestine. In many cases, SIBO is caused by bacteria in the colon moving into the small intestine, but it can also be caused by overgrowth of the normal inhabitants of the small intestine. A stool test can give a general idea of what microbes may be migrating into the small intestine and other good information, but is not going to provide a definitive diagnosis for SIBO.

Thank you for this wonderful article! I have candida and am waiting for results for the SIBO test. Do you think diet and herbals can eradicate candida. I’m not sure what your diet plan is for candida but I would imagine it would be pretty unhealthy long-term if it omits most fruits and carbs. I am hoping my candida has not turned to SIBO and I can try to fix this with just diet and herbals. Thanks again for the article!:)

In most cases, Candida is not eradicated completely. It is managed. Diet and herbals will help manage. There is no long term harm in omitting fruit and carbs. Carbohydrates are a completely non-essential nutrient. The body will make the glucose that it needs from protein and fat through gluconeogenesis. You’re welcome.

I read your article which is interesting. Im trying to figure out whats wrong. I have been sick with symptoms described as candida and HP, ever since i moved in to my current apartment, which i believe has mold in walls and under the sinks. Was just tested negative for HP via breath test to my surprise. I was living with someone who had it and suddenly had similar symptoms such as extreme fatigue, especially after eating, sleeping more than ever (8-12) hours, and still waking up tired. Nauseas all the time, feeling weak, looking pale, loosing hair, finger nails look weak (always had strong looking soft nails.) white tongue (started 2,5 years ago also when i moved in, perhaps due to a round of antibiotics before moving in 3 years ago). I have no clue anymore what it is, doctors say bloodwork is fine, and next up is an endoscopy, which i dont feel like doing. Have you had any experience with mold, I believe there is a connection? It feels like my stomach is alive, around the bellybutton area i guess, and a bit all over. I dont have excess gas, at least not for a long time, but perhaps thats because i eat less. When i drink coke or go out, the nauseas seems to improve a bit. I also burp frequently, which i never did before all this, Getting desperate. 🙁

Living in a moldy environment can cause or perpetuate a problem with Candida, other gut problems and immune system issues. Your symptoms sound like a combination of SIBO and Candida and maybe H. pylori as well. Not uncommon for all three to be present. White tongue is definitely a Candida issue. Stuff around the belly button is often SIBO. Take a look at the Candida and SIBO sections found here

What is your thoughts on underlying lyme or Lyme like disease from this or moldy environment bringing out things through weakend immune system from all this? Have you found that clients may have these issues causing them to not get better?

Many people with Candida/SIBO/Hpylori have Lyme, but not always. It is hard to know which one came first.

Living in a moldy environment can weaken the immune system and/or make one more hypersensitive to fungi and other pathogens. Many practitioners report a connection between Candida overgrowth and living in mold and that treatment is a lot more difficult if the individual continues to stay in that environment. On the other hand, Candida overgrowth can make you more susceptible to mold issues. So again, it is sometimes hard to know which came first.

Thank you for this exceptional article. I have not read all the links yet but intend to several times. Do you know anything about kefir mushroom grains? I have been taking this natural probiotic for a year now and while a lot of my symptoms have been alleviated, I am now waking at 3 am with gas, palpitations, sweating and bowel movements for sometimes two hours. What is your opinion please? also, do you recommend detoxing to help with any problems.

Hello, In trying to better understand SIBO I started to research the connection between H. Pylori and SIBO. A little over two years ago I have severe pain in my upper gut and I was tested for H. Pylori and then given an intense antibiotic treatment where I became more sick. Two years of pain and I finally found a naturopath and nurtitionist I love. I was tested for SIBO with the breath test and it came back with high hydrogen levels. I completed a two week round of antibiotocs for the SIBO but, it is not cleared yet and I am on berberine. It has been an epic journey trying to find out what was wrong with me and getting support. I am very happy to find this article.

It’s very common for test results to be negative when dealing with Candida, SIBO and H. Pylori. That does not mean they are not present. A doctor who has knowledge with these conditions will typically treat anyhow if symptoms suggest otherwise. Find a doctor with knowledge in these areas.

Thanks for all the valuable information you share! Do you have thoughts on using the Elemental Diet ( a homemade version )as a way to clear SIBO? Since I also have Candidia I wonder if that diet could be done without the carbohydrate portion.

Based on your analysis, it seems i have sibo and not yeast (no positive breath test yet). I’m doing elemental diet right now (Integrative therapeutics physician’s elemental) with prokinetics (5-htp, triphalia herb, ginger, biofilm defense kirkman) and am finding myself having very loud belching 5-10 times a day. I’m unsure of this is due to bacterial die-off or feeding the yeast. I’ve tried the usual suite of herbal antimicrobials/antifungals for SIBO with relief but no complete remission, hence why I’m at elemental.

Pretty much nobody achieves complete remission. In most cases, SIBO and Candida are not cured, they are managed. They are managed by treating repeatedly and remaining faithful with the diet on an ongoing basis.

The loud belching is more related to SIBO than Candida. Could also be H. pylori.

There can be some belching with die off, but if it is really bad, then maybe something in your formula is feeding it. May be best to have no carbohydrate in the elemental formula.

All testing for Candida is pretty poor. Like all microbes, it is very good at evading detection. The most reliable test is the long version of Dr. Crook’s yeast questionnaire. As far as lab tests go, the best lab test for Candida is the Great Plains Organic Acids Test. You can purchase yourself without a doctor visit on the following page, if interested. It also identifies bacteria.

Hi, Thanks for the great article. I have been diagnosed with SIBO and candida, my doc has advised that I must focus on the candida first as treating the SIBO first could make the candida worse. What are your thoughts on this? My plan is to do a no sugar, low carb diet to treat both, take the antifungals first and then the antibiotics for SIBO once the candida is under control. Thanks!

Hi Lauren, In most cases Candida and SIBO are not cured, they are managed. Therefore, both conditions should be addressed simultaneously. I suggest you take a look at my new book, which goes into depth on both Candida and SIBO, found here.

Hi, I just read almost all your articles, very educative. I suffered, all my life, from mechanical colon and rectum blockage, and now I’m sure I got candida. My stomach is extremely inflamated all the time, Drs don’t help me; they say I suffer from IBS and to take laxatives. I need a good diet for SIBO, for Candida and Gerd. Thank you.